Bigotry as Mental Illness Or Just Another Norm

By EMILY EAKIN

Published: January 15, 2000

In 1851, Dr. Samuel A. Cartwright, a Louisiana surgeon and psychologist, filed a report in the New Orleans Medical and Surgical Journal on diseases prevalent among the South's black population. Among the various maladies Dr. Cartwright described was ''drapetomania'' or ''the disease causing slaves to run away.''

Though a serious mental illness, drapetomania, wrote Dr. Cartwright, was happily quite treatable: ''The cause, in the most of cases, that induces the negro to run away from service, is as much a disease of the mind as any other species of mental alienation, and much more curable. With the advantages of proper medical advice, strictly followed, this troublesome practice that many negroes have of running away can be almost entirely prevented.''

A particularly absurd chapter in the annals of racist 19th-century science? Without question, but for Alvin Poussaint, a clinical professor of psychiatry at Harvard Medical School, Cartwright's hopelessly unscientific diagnosis is of more than just historical interest. It is a vivid illustration of how definitions of normal and abnormal behavior are shaped by the values of the society that makes them. ''The culture influences what you consider pathology,'' says Dr. Poussaint. ''Cartwright saw slavery as normative. So when slaves deviated from the norm, he called them mentally ill. The business of deciding what's normal and what's psychopathology gets influenced by culture and politics. It's not hard science.''

Dr. Poussaint says that when it comes to understanding racism, contemporary psychiatry is as in the dark about its own biases as the benighted Dr. Cartwright. Dr. Poussaint's argument is not with racist psychiatrists but with the psychiatry of racism. Is racism a mental disorder?

The debate is decades old, but was recently reignited when John Rocker, a pitcher for the Atlanta Braves, made bigoted statements about blacks, homosexuals and foreigners last month in the pages of Sports Illustrated. Last week Mr. Rocker was ordered by the commissioner of major league baseball to undergo a psychological evaluation. Since then, fans, therapists, pundits, sports figures, talk show hosts and columnists have all weighed in on the degree to which his comments and the league's decision were based on science, stupidity, financial concerns and spin control.

For most psychiatrists, the answer is clear: racism is unacceptable social behavior, but not evidence of a mental disorder. There is no entry for racism in the latest edition of the Diagnostic and Statistical Manual, a compendium of mental illnesses known as D.S.M.-IV.

''If psychiatry were to define racism as a mental disorder, you'd have to include the Nazis, and the Serbs who hate Muslims -- there would be no end,'' says Dr. Robert Spitzer, a psychiatrist at the New York State Psychiatric Institute and a consultant on the D.S.M.-IV. ''Almost everyone would be ill.''

Nevertheless, Dr. Spitzer concedes that prevalence alone does not negate a need for diagnosis. To meet the American Psychiatric Association's criteria for a distinct mental disorder, he says, psychiatrists would have to show that a racist's mental processes interfered with normal functioning.

Dr. Poussaint says he can do that. Arguing that racism can sometimes -- though not all the time -- be a mental disorder, he says that racists frequently exhibit symptoms associated with major psychopathology, including paranoia (feeling threatened unrealistically by a particular group), projection (imbuing this group with traits that have negative associations) and fixed beliefs (categorical opinions like ''all foreigners are dumb''). The real reason the psychiatric association hasn't made racism a mental health issue, he argues, is because ''it hasn't been a mental health issue for them.'' To pathologize racism, he said, would require its members ''to look at their friends, their relatives, and themselves'' in an uncomfortable light.

It's true that the A.P.A. is predominantly white and male. Of its current 38,200 members, only 865, or 2.3 percent, are African-American and 1,720, or 4.5 percent, are Hispanic. Some 12,000, or 31 percent, are women. And there is no doubt that psychiatry has been susceptible to some of the same biases harbored by the society at large, most notably toward women and homosexuals. Until well after World War II, instruction in now-discredited Freudian concepts like ''penis envy'' and ''castrating female'' was a routine part of psychiatric training. More egregious was the theory of the schizophrenic mother, whose bad parenting was supposedly to blame for her child's schizophrenia. Widely accepted well into the 1970's, the theory has been supplanted by explanations focusing on brain chemistry and biology.

Homosexuals fared little better. Until the early 1970's, the A.P.A. regarded homosexuality as a pathology. After heavy lobbying from gay rights activists, including a psychiatrist who was a member of the A.P.A. and who spoke at the 1972 annual meeting, his face concealed by a mask to preserve his anonymity, the board of trustees voted to remove homosexuality from the D.S.M.-IV. The membership followed suit in 1974. (One bemused observer labeled it ''the single greatest cure in the history of psychiatry.'')